Recovery of Graft Function Early Posttransplant Determines Long-Term Graft Survival in Deceased Donor Renal Transplants

Abstract Introduction: Delayed graft function (DGF) is a frequent complication after deceased donor kidney transplantation with an impact on the prognosis of the transplant. Despite this, long-term impact of DGF on graft function after deceased donor kidney transplantation has not been properly evaluated. Objective: The main objective of this study was to evaluate risk factors for DGF and the impact of its occurrence and length on graft survival and function. Methods: A retrospective cohort study was performed in 517 kidney transplant recipients who received a deceased donor organ between January 2008 and December 2013. Results: The incidence of DGF was 69.3% and it was independently associated with donor's final serum creatinine and age, cold ischemia time, use of antibody induction therapy and recipient's diabetes mellitus. The occurrence of DGF was also associated with a higher incidence of Banff ≥ 1A grade acute rejection (P = 0.017), lower graft function up to six years after transplantation and lower death-censored graft survival at 1 and 5 years (P < 0.05). DGF period longer than 14 days was associated with higher incidence of death-censored graft loss (P = 0.038) and poorer graft function (P < 0.001). No differences were found in patient survival. Conclusions: The occurrence of DGF has a long-lasting detrimental impact on graft function and survival and this impact is even more pronounced when DGF lasts longer than two weeks.

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Influence of Multiple Donor Renal Arteries on the Outcome and Graft Survival in Deceased Donor Kidney Transplantation

Journal of Clinical Medicine ◽

10.3390/jcm10194395 ◽

2021 ◽

Vol 10 (19) ◽

pp. 4395

Author(s):

Uwe Scheuermann ◽

Sebastian Rademacher ◽

Tristan Wagner ◽

Andri Lederer ◽

Hans-Michael Hau ◽

...

Keyword(s):

Kidney Transplantation ◽

Renal Artery ◽

Graft Survival ◽

Graft Function ◽

Deceased Donor ◽

Renal Arteries ◽

Term Outcome ◽

Long Term Outcome ◽

Arterial Anastomosis

Aim: Complex arterial reconstruction in kidney transplantation (KT) using kidneys from deceased donors (DD) warrants additional study since little is known about the effects on the mid- and long-term outcome and graft survival. Methods: A total of 451 patients receiving deceased donor KT in our department between 1993 and 2017 were included in our study. Patients were divided into three groups according to the number of arteries and anastomosis: (A) 1 renal artery, 1 arterial anastomosis (N = 369); (B) >1 renal artery, 1 arterial anastomosis (N = 47); and (C) >1 renal artery, >1 arterial anastomosis (N = 35). Furthermore, the influence of localization of the arterial anastomosis (common iliac artery (CIA), versus non-CIA) was analyzed. Clinicopathological characteristics, outcome, and graft and patient survival of all groups were compared retrospectively. Results: With growing vascular complexity, the time of warm ischemia increased significantly (groups A, B, and C: 40 ± 19 min, 45 ± 19 min, and 50 ± 17 min, respectively; p = 0.006). Furthermore, the duration of operation was prolonged, although this did not reach significance (groups A, B, and C: 175 ± 98 min, 180 ± 35 min, and 210 ± 43 min, respectively; p = 0.352). There were no significant differences regarding surgical complications, post-transplant kidney function (delayed graft function, initial non-function, episodes of acute rejection), or long-term graft survival. Regarding the localization of the arterial anastomosis, non-CIA was an independent prognostic factor for deep vein thrombosis in multivariate analysis (CIA versus non-CIA: OR 11.551; 95% CI, 1.218–109.554; p = 0.033). Conclusion: Multiple-donor renal arteries should not be considered a contraindication to deceased KT, as morbidity rates and long-term outcomes seem to be comparable with grafts with single arteries and less complex anastomoses.

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Long-term Effects of Delayed Graft Function on Pancreas Graft Survival After Pancreas Transplantation

Transplantation Journal ◽

10.1097/tp.0000000000000214 ◽

2014 ◽

Vol 98 (12) ◽

pp. 1316-1322 ◽

Cited By ~ 9

Author(s):

Sung Shin ◽

Duck Jong Han ◽

Young Hoon Kim ◽

Seungbong Han ◽

Byung Hyun Choi ◽

...

Keyword(s):

Graft Survival ◽

Pancreas Transplantation ◽

Graft Function ◽

Delayed Graft Function ◽

Long Term Effects ◽

Pancreas Graft

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Timing of Kidney Clamping and Deceased Donor Kidney Transplant Outcomes

Clinical Journal of the American Society of Nephrology ◽

10.2215/cjn.03290321 ◽

2021 ◽

pp. CJN.03290321

Author(s):

Simon Ville ◽

Marine Lorent ◽

Clarisse Kerleau ◽

Anders Asberg ◽

Christophe Legendre ◽

...

Keyword(s):

Kidney Transplant ◽

Graft Survival ◽

Ischemia Reperfusion ◽

Multivariable Analysis ◽

Graft Function ◽

Deceased Donor ◽

Kidney Graft ◽

Kidney Transplant Recipients ◽

Heart Beating ◽

Deceased Donor Kidney Transplant

BackgroundThe recognition that metabolism and immune function are regulated by an endogenous molecular clock generating circadian rhythms suggests that the magnitude of ischemia-reperfusion and subsequent inflammation on kidney transplantation, could be affected by the time of the day. MethodsAccordingly, we evaluated 5026 first kidney transplant recipients from deceased heart-beating donors. In a cause-specific multivariable analysis, we compare delayed graft function (DGF) and graft survival according to the time of kidney clamping and declamping. Participants were divided into clamping between midnight and noon (AM clamping group, 65%) or clamping between noon and midnight (PM clamping group, 35%), and similarly, AM declamping or PM declamping (25% / 75%). ResultsDGF occurred among 550 participants (27%) with AM clamping and 339 (34%) with PM clamping (adjusted OR = 0.81, 95%CI: 0.67 to 0.98, p= 0.03). No significant association of clamping time with overall death censored graft survival was observed (HR = 0.92, 95%CI: 0.77 to 1.10, p= 0.37). No significant association of declamping time with DGF or graft survival was observed. ConclusionsClamping between midnight and noon was associated with a lower incidence of DGF whilst the declamping time was not associated with kidney graft outcomes.

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Effects of body weight variation in obese kidney recipients: a retrospective cohort study

Clinical Kidney Journal ◽

10.1093/ckj/sfz124 ◽

2019 ◽

Vol 13 (6) ◽

pp. 1068-1076 ◽

Cited By ~ 1

Author(s):

Nuria Montero ◽

Maria Quero ◽

Emma Arcos ◽

Jordi Comas ◽

Inés Rama ◽

...

Keyword(s):

Body Weight ◽

Graft Survival ◽

Graft Function ◽

Obese Patients ◽

Weight Changes ◽

Kidney Transplant Recipients ◽

Post Transplantation ◽

Kidney Recipients ◽

Weight Variation

Abstract Background Obese kidney allograft recipients have worse results in kidney transplantation (KT). However, there is lack of information regarding the effect of body mass index (BMI) variation after KT. The objective of the study was to evaluate the effects of body weight changes in obese kidney transplant recipients. Methods In this study we used data from the Catalan Renal Registry that included KT recipients from 1990 to 2011 (n = 5607). The annual change in post-transplantation BMI was calculated. The main outcome variables were delayed graft function (DGF), estimated glomerular filtration rate (eGFR) and patient and graft survival. Results Obesity was observed in 609 patients (10.9%) at the time of transplantation. The incidence of DGF was significantly higher in obese patients (40.4% versus 28.3%; P < 0.001). Baseline obesity was significantly associated with worse short- and long-term graft survival (P < 0.05) and worse graft function during the follow-up (P < 0.005). BMI variations in obese patients did not improve eGFR or graft or patient survival. Conclusions Our conclusion is that in obese patients, decreasing body weight after KT does not improve either short-term graft outcomes or long-term renal function.

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The Neglectable Impact of Delayed Graft Function on Long-term Graft Survival in Kidneys Donated After Circulatory Death Associates With Superior Organ Resilience

Annals of Surgery ◽

10.1097/sla.0000000000003515 ◽

2019 ◽

Vol 270 (5) ◽

pp. 877-883 ◽

Cited By ~ 7

Author(s):

Michèle J. de Kok ◽

Dagmara McGuinness ◽

Paul G. Shiels ◽

Dorottya K. de Vries ◽

Joanne B. Tutein Nolthenius ◽

...

Keyword(s):

Graft Survival ◽

Graft Function ◽

Delayed Graft Function ◽

Circulatory Death

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Predictors and one-year outcomes of patients with delayed graft function after deceased donor kidney transplantation

BMC Nephrology ◽

10.1186/s12882-020-02181-1 ◽

2020 ◽

Vol 21 (1) ◽

Author(s):

Rao Chen ◽

Haifeng Wang ◽

Lei Song ◽

Jianfei Hou ◽

Jiawei Peng ◽

...

Keyword(s):

Kidney Transplantation ◽

Graft Survival ◽

Graft Function ◽

Deceased Donor ◽

Donor Kidney ◽

Ischemic Time ◽

Deceased Donor Kidney ◽

One Year ◽

Donor Kidney Transplantation ◽

Deceased Donor Kidney Transplantation

Abstract Background Delayed graft function (DGF) is closely associated with the use of marginal donated kidneys due to deficits during transplantation and in recipients. We aimed to predict the incidence of DGF and evaluate its effect on graft survival. Methods This retrospective study on kidney transplantation was conducted from January 1, 2018, to December 31, 2019, at the Second Xiangya Hospital of Central South University. We classified recipients whose operations were performed in different years into training and validation cohorts and used data from the training cohort to analyze predictors of DGF. A nomogram was then constructed to predict the likelihood of DGF based on these predictors. Results The incidence rate of DGF was 16.92%. Binary logistic regression analysis showed correlations between the incidence of DGF and cold ischemic time (CIT), warm ischemic time (WIT), terminal serum creatine (Scr) concentration, duration of pretransplant dialysis, primary cause of donor death, and usage of LifePort. The internal accuracy of the nomogram was 83.12%. One-year graft survival rates were 93.59 and 99.74%, respectively, for the groups with and without DGF (P < 0.05). Conclusion The nomogram established in this study showed good accuracy in predicting DGF after deceased donor kidney transplantation; additionally, DGF decreased one-year graft survival.

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P1690EXPERIENCE WITH EXPANDED CRITERIA DONORS: 10-YEAR SINGLE CENTER ANALYSIS

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfaa142.p1690 ◽

2020 ◽

Vol 35 (Supplement_3) ◽

Author(s):

Karol Graňák ◽

Vnuäã¡k Matej ◽

Petra Skálová ◽

Juraj Miklušica ◽

Ľudovít Laca ◽

...

Keyword(s):

Graft Survival ◽

Patient Survival ◽

Graft Function ◽

Organ Transplant ◽

First Year ◽

Transplant Program ◽

Basic Parameters ◽

Expanded Criteria ◽

Expanded Criteria Donors

Abstract Background and Aims Kidneys from expanded criteria donors with diagnosis of brain death have become a part of the organ transplant program, which have thus increased the number of transplants. Method In this retrospective analysis, we identified the expanded criteria donors in a group of 156 kidney donors at our center. Basic parameters of the donors before kidney recovery were collected. Graft function, graft survival, and patient survival at 1, 3, and 5 years posttransplant were compared in expanded criteria versus standard criteria donors. Results Expanded criteria donors were significantly older than standard criteria donors (P < .001), had higher body mass index (P = .006), and had more frequent arterial hypertension (P < .001) and diabetes mellitus (P = .004) in their histories. When we considered the estimated glomerular filtration rate, graft function in the first 6 months after transplant was significantly worse in kidneys from expanded criteria donors (P = .011). In addition, recipients of grafts from expanded criteria donors had significantly worse survival in the first year posttransplant (P = .023); however, no differences in graft survival were observed. Conclusion From the long-term aspect, graft function and graft and patient survival in cases of kidneys from expanded criteria donors were comparable to results with kidneys from standard criteria donors. Expanded use of organs available for transplant is important due to the constantly increasing demands versus limited offers of organs.

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